Movement Therapy Helps Stroke Patients

Study Shows Long-Term Benefit From Constraint-Induced Movement Therapy

Medically Reviewed by Louise Chang, MD on December 11, 2007
From the WebMD Archives

Dec.11, 2007 -- Stroke patients with mild to moderate impairments can reap long-lasting benefits from a two-week program of specialized movement therapy, according to a study that tracked them for two years.

The new study was a continuation of previous research that showed the patients retained their improvement in upper limb functioning 12 months after the treatment, called constraint-induced movement therapy.

The most recent study is more good news, according to researcher Steven L. Wolf, PT, PhD, professor of rehabilitation medicine at the Emory University School of Medicine, Atlanta. It is published online and in the January issue of The Lancet Neurology.

"Two weeks of constraint-induced movement therapy given to patients with mild to moderate stroke has sustainable improvements that are still seen two years later," Wolf tells WebMD.

How Constraint-Induced Movement Therapy Works

During the treatment, a patient's less-affected wrist and hand are restrained during most of their waking hours. A therapist guides them in using the affected limb to practice repetitive tasks that are functionally relevant, working with them for up to six hours a day.

The treatment differs, Wolf says, from so-called forced-use therapy, in which the patient uses the impaired limb while the other is restrained but does not receive formal training.

The new study assesses how well stroke patients enrolled in the EXCITE trial (extremity constraint-induced movement therapy evaluation) kept the improvement in movement 24 months after receiving the intensive treatment.

In the trial, 106 of the 222 participants were randomly assigned to the treatment or to "usual or customary" care, which could include traditional physical therapy or other measures, Wolf says. The treatment began three to nine months after the stroke and went on for two weeks.

"There was no formalized training after the two weeks," Wolf says, although the patients may have continued practicing at home.

Every four months, the patients were evaluated to see how well their impaired upper limb improved as far as movement ability, quality of life, and measures such as their willingness to participate socially.

"After one year, the delayed group, or control group, also got intervention," Wolf says.

At the two-year follow-up, the improvement persisted, Wolf and his colleagues found. "Strength in their grip and in their ability to lift weight improved. It was better than at the 12-month mark."

Health-related quality-of-life measures such as social participation improved substantially.

Candidates for Constraint-Induced Movement Therapy

Participants in the study had to be capable of some initial movement in the limb affected by the stroke, Wolf says. With their wrist hanging over a table, palm down, for instance, a stroke patient had to be able to raise the hand without lifting the arm.

"Up to 30% of the stroke population, we think, could benefit from this therapy," Wolf tells WebMD. About 700,000 Americans have a stroke each year, according to the American Stroke Association.

Participants in the trial who were part of the "delayed treatment" group -- which got movement therapy a year later than the others -- weren't included in the two-year follow-up. At the two-year analysis, 34% of the "immediate treatment" patients had dropped out.

The therapy is widely available, Wolf says, but is typically not reimbursed by insurance. The cost is about $10,000, Wolf says, not including travel costs to a center.

Second Opinions

The movement therapy is worth a try, according to the American Heart Association. In its 2005 stroke rehab guidelines, the association says that constraint-induced therapy should be considered for a select group of patients -- those with sufficient wrist and finger extension who are free of sensory and cognitive defects.

According to the guidelines, the only demonstrated benefit is to those receiving six to eight hours of daily training for at least two weeks.

The American Physical Therapy Association does not have a position on any treatment method, including constraint-induced therapy. But spokeswoman Jennifer Rondon says the association supports research on the therapy.

Show Sources

SOURCES: Steven L. Wolf, PT, PhD, professor of rehabilitation medicine, Emory University School of Medicine, Atlanta. Wolf, S.L. The Lancet Neurology, January 2008; vol 7: pp 33-40. Jennifer Rondon, spokeswoman, American Physical Therapy Association. Karen Astle, spokeswoman, American Heart Association.

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